Policy Documents

A State of the Union Without Health Care?

June 30, 2010

As President Barack Obama prepares to give his State of the Union remarks tonight to the assembled Congress, the single most significant domestic policy focus of his first year in office is in tatters. The options for health care reform's survival in its current form are few in number and even fewer if you account for political probability.

Just last night, House progressives made an attempt to force the Senate to reopen the issue of the public option -- suggesting, according to this report at The Huffington Post, that adding the much-maligned government-run health care option to the bill would make it more palatable for the House. According to reporter Ryan Grim:

They argued that the current bill before the House, which passed the Senate, lacks the votes needed to pass because pro-life Democrats don't believe the abortion restrictions go far enough and progressive Democrats don't like the lack of a public option, the weak affordability measures or the tax on private insurance. And nobody likes the Cornhusker Kickback, a provision won by Nebraska Sen. Ben Nelson that would cover the state's Medicaid bills in perpetuity. Not even Nelson likes it anymore.

So, in order to move health care through the House, Democrats either need to pick up progressives or conservatives. And the budget reconciliation process does not lend itself to altering abortion language reform, because that wouldn't have a direct, substantial impact on the budget.

That leaves progressives as the bloc available to pick up. Their demands -- changes related to the tax on insurance, a Medicaid or Medicare expansion, and a public option -- would likely be allowable using reconciliation. (The Senate parliamentarian would have the final say.)

Of course, this calculation would require a surprising and as yet unseen amount of partisan loyalty on the part of the reluctant Senate. Already two Senators have come out in opposition to doing anything via reconciliation, and Majority Leader Harry Reid is clearly in a bind. USA Today reports:

"There is no rush," Senate Majority Leader Harry Reid, D-Nev., said after a meeting of Senate Democrats. His comments came as two centrists said they would oppose the plan Democratic leaders were considering to reconcile differences between the House and Senate bills and put comprehensive legislation on Obama's desk...Reid said he'll keep talking with House Democrats and White House officials, noting that the Senate-passed bill is good for the year.

Two centrist senators threw up a new roadblock. Sens. Evan Bayh, D-Ind., and Blanche Lincoln, D-Ark. — both face re-election this year in Republican-leaning states — said they would oppose using a special budget-related procedure to go around Republican opponents in the Senate, a calculated risk sure to inflame critics on the political right.

It's difficult to see a path forward for Reid's bill, especially now that Democrats seem eager to put the issue on the backburner. What's more, Americans continue to raise their opposition to the legislation, with the latest Gallup poll indicating a full 55 percent of Americans want the Congress to start over from scratch.

All of this could create a circumstance where President Obama does what was, just weeks ago, unthinkable -- he could leave health care out of his State of the Union speech almost entirely, and devote himself solely to speaking in vague terms about moving forward.